Provider Demographics
NPI:1215522412
Name:RUOFF, ALLIE (PTA)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:RUOFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12467 S HALLET ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6087
Mailing Address - Country:US
Mailing Address - Phone:913-953-2710
Mailing Address - Fax:
Practice Address - Street 1:12467 S HALLET ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6087
Practice Address - Country:US
Practice Address - Phone:913-953-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03815225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant